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IN THIS ARTICLE WE SUGGEST a clinical stance for the treatment of adult survivors of childhood sexual abuse. Building on current psychoanalytic viewpoints, we focus on what we consider to be the most fundamental damage done to the psychic integrity of the abuse survivor, examine some of its sources in the abuse experience, and suggest a perspective for addressing the complex clinical problems that often arise in working with survivors of sexual abuse.
We begin with two observations familiar to clinicians working in this area. One is that sexually abused patients tend to be extremely compelling. But it is not just the trauma they have experienced that lends this compelling quality. Sometimes neither they nor the therapist know about the trauma at the beginning of treatment. Rather, it is a quality about them as people that is very powerful, and in our experience, very distinctive. There is something about them as individuals and about their stories that stirs a deep responsiveness. That responsiveness may lead to actions and behaviors on the part of therapists that they might never